Hemorrhage of AV fistula

Background

• Potentially life-threatening
• Can result from aneurysms, anastomosis rupture, or over-anticoagulation

Types

• Aneursym (true)
  • Most are asymptomatic; rarely rupture
• Pseudoaneurysm
  • Results from subcutaneous extravasation of blood from puncture sites
  • Bleeding from puncture site is usually controlled by digital pressure or subq suture
  • Consider vascular surgery consultation for continued bleeding or infection
  • Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm

Differential Diagnosis

AV Fistula Complications

• Clotting of AV fistula
• Infection of AV fistula
• Hemorrhage of AV fistula
• Vascular insufficiency from AV fistula
• AV fistula aneurysm/pseudoaneurysm
• High-output heart failure from AV fistula

Workup

• Consider Doppler US

Management

• Control bleeding w/ pressure applied to puncture site for 5-10min; observe for 1-2hr

See Also

• Dialysis complications